Brain Bleeds - Haemorragic Strokes

Question 1

Subarachnoid haemorrhage 3 causes

Answer 1

Trauma causes artery to rupture
Berry aneurysm rupture
Arteriovenous malformations

Question 2

Subarachnoid haemorrhage typical presentation

Answer 2

Sudden, thunderclap, worst ever headache
Vomiting/nausea
Collapse, seizures, coma may follow

Neck stiffness (and Kernigs sign - often after 6hours)
Other signs/symptoms can suggest site

Question 3

What thing in the abdomen may suggest higher risk of berry aneurysm?

Answer 3

Polycystic kidney disease

Question 4

Tests for subarachnoid haemorrhage

Answer 4

CT head

lumbar puncture - red = fresh blood cells, yellow = old RBCs, xanthrochromia

Question 5

Management of subarachnoid haemorrhage

Answer 5

Neurosurgery when proven (endovascular coiling, clipping, stents etc)
Maintain cerebral perfusion with hydration
Nimodipine (CCB) - reduces vasospasm which can occur with blood in Subarachnoid space - this would otherwise cause more damage by vasoconstriction of cerebral blood vessels

Question 6

Subdural haemorrhage - pathophysiology

Answer 6

Bridging veins between cortex and venous sinuses tear.
This causes a haematoma between the dura and arachnoid layers. ICP increases and midline shifts can occur
Most common in elderly who fall, because of brain atrophy. Alcoholics also at risk.

The fall/trauma can be from up to 9 months ago and is often forgotten

Question 7

Symptoms of subdural haemorrhage

Answer 7

Fluctuating GCS
Physical/intellectual slowly slowing 
Sleepiness 
Headache 
Personality change
Unsteadiness

Question 8

Signs of subdural haemorrhage

Answer 8

Raised ICP
Seizures
Unequal pupils - late sign

Question 9

Subdural haemorrhage - test and what you see

Answer 9

CT/MRI - clot, midline shift and the crescent shaped bleed area on one side

Question 10

Treatment of subdural haemorrhage

Answer 10

Burrhole neurosurgery to irrigate/evacuate

Question 11

Extra dural haemorrhage - common cause and presentation

Answer 11

Head injury - GCS declines, after lucid interval, slow to improve
Often due to fractured temporal/parietal bone tearing the middle meningeal artery
Later - worsening headache, vomiting, fits, confusion
Hemiparesis, up going plantars
Ipsilateral pupil dilation, coma, death

Question 12

Extra dural bleed - tests

Answer 12

CT head - shows a lens shape, round bleed

Do NOT lumbar puncture

Question 13

Extra dural bleed - management

Answer 13

Neurosurgery - clot evacuation